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[Pemphigus vulgaris: an unusual clinical presentation].
- Source :
-
Annales de dermatologie et de venereologie [Ann Dermatol Venereol] 2013 Feb; Vol. 140 (2), pp. 116-9. Date of Electronic Publication: 2012 Dec 27. - Publication Year :
- 2013
-
Abstract
- Background: Pemphigus vulgaris is a bullous auto-immune disease affecting the skin and mucosa. It is characterised by acantholysis that results in the formation of intraepithelial bullous lesions. Herein we report a case distinguished by its unusual clinical presentation.<br />Patients and Methods: A 45-year-old man, a chronic smoker, consulted for hyperkeratotic lesions of the toes on the right foot present for 5 months. Examination revealed a violet colour of the toes associated with localised yellowish keratoderma on the sole of the foot and impaired toe nails, as well as impairment on the nails of the first, third and fourth fingers on the right hand. In addition, two hyperkeratotic plaques with crusts were noted on the patient's forehead. Histological examination of a biopsy sample taken from the nail bed of the fourth toe on the right foot showed suprabasal acantholysis with a characteristic tombstone appearance. Direct immunofluorescence confirmed the diagnosis of pemphigus. Oral corticosteroid therapy was initiated consisting of prednisone 1.5mg/kg per day. Improvement of the nail lesions and subsidence of the lesions on the patient's forehead occurred after three months of treatment.<br />Discussion: During the course of pemphigus, the nail findings most commonly reported in the literature are paronychia, onychomadesis and onycholysis. However, these signs are generally seen in patients with known pemphigus vulgaris and only rarely indicate bullous disease. The case we report illustrates a special situation in which pemphigus vulgaris was revealed by unusual skin and nail lesions.<br /> (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)
- Subjects :
- Acantholysis diagnosis
Acantholysis pathology
Facial Dermatoses diagnosis
Facial Dermatoses drug therapy
Fluorescent Antibody Technique, Direct
Foot Dermatoses drug therapy
Foot Dermatoses pathology
Humans
Immunosuppressive Agents therapeutic use
Keratosis diagnosis
Keratosis pathology
Male
Middle Aged
Nail Diseases drug therapy
Nail Diseases pathology
Pemphigus drug therapy
Pemphigus pathology
Prednisone therapeutic use
Toes pathology
Foot Dermatoses diagnosis
Nail Diseases diagnosis
Pemphigus diagnosis
Subjects
Details
- Language :
- French
- ISSN :
- 0151-9638
- Volume :
- 140
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Annales de dermatologie et de venereologie
- Publication Type :
- Academic Journal
- Accession number :
- 23395493
- Full Text :
- https://doi.org/10.1016/j.annder.2012.11.005